Health Information Exchange (HIE) Implementations Encounter Obstacles

Dylan Scott | Governing | February 9, 2012

The issue of governance has been raised repeatedly as states, cities and regions seek to implement exchanges. Different states have populated their HIE governance boards in different ways, according to Brookings. California and Massachusetts, for example, have union representatives on their boards, but most other states do not. Tennessee’s board includes pharmacists and nurses.

Bringing all stakeholders together and involving them in the decision-making process will facilitate the trust necessary for effective exchanges, the panelists agreed. And without HIEs, they said, health IT can’t reach its full potential for improving the overall health-care system. Adopting EHRs without properly functioning exchanges “is sort of like getting all dressed up for the prom and you don’t have a date,” said White.

States are also pursuing diverse policies to address budgetary concerns about HIEs, according to Brookings. Those concerns are substantial: only 10 percent of HIEs self-report that they have a sustainable business model. Even Indiana, one of the oldest and most respected state exchanges, had an operating loss of nearly $275,000 in 2010. Vermont has begun funding its exchange with state tax dollars. Delaware launched an initiative to earn revenue through public health and Centers for Disease Control and Prevention reporting. Tennessee has proposed a one percent medical claims fee to pay for its exchange...


Higher HIT Priorities

State HIE efforts continue to struggle and make progress. Of equal or higher priority is the need to implement EHR systems and local HIE networks that are key to success and use of State HIE networks. PHR systems follow closely behind in priority, along with mHealth apps.